A dramatic spike in the number of overdose deaths in B.C. related to the drug fentanyl is causing alarm because users may be mistaking it for either heroin or other street drugs.

VANCOUVER -- B.C. health workers were warned Thursday to watch out for potential overdoses involving the drug fentanyl, an opiate often mistaken for heroin that is believed to be linked to 23 deaths so far this year.

Provincial health officer Dr. Perry Kendall said the unusual alert was issued following a spike in the preliminary number of fentanyl-related deaths in the first four months of 2013, as well as a large seizure of the illicit drug by Vancouver police.

Fentanyl, an opioid used to manage severe pain in cancer patients, is considered similar to heroin and oxycodone — and can look identical — but is far more potent in smaller doses.

There were 20 fentanyl-related deaths in all of 2012, and eight a year earlier.

Health officials warn the emergence of fentanyl as a street drug shouldn’t be underestimated: In 2006 a fentanyl epidemic in Chicago killed 342 people.

Kendall said he was alerted to the trend about a week ago by the B.C. Coroners Service.

Dr. Kelly Barnard, executive director of the medical unit with the B.C. Coroners Service, said it’s still not known precisely what role fentanyl played in the 23 cases, but the coroner’s service agreed to release the information now because of concerns from police and health workers raised in the past month and a half.

“In this circumstance, where there’s an emerging issue requiring public health attention, we’ll share this information,” Barnard said. “We normally wouldn’t be doing a tally, but because we were concerned we specifically looked into it ...

“It was just something unexpected. As both the police and public health officials put the pieces together it became clear something more was happening.”

Barnard noted that as cases are scattered across the province, a trend isn’t always evident, especially as it takes time to conduct toxicology tests.

The coroner’s service decided to raise the alarm once the trend became apparent, although she said “ you want to be cautious in drawing attention to things in a way that might be harmful.”

The danger apparently lies in the fact drug dealers who are making the product in their own labs have made it confusingly similar in appearance to other less potent but equally dangerous drugs, the provincial health ministry said in a statement Thursday. People then take the drug thinking it is something else.

“People talk of bad heroin as extra strong heroin. This is many times more potent,” Kendall said. “If you take an equivalent amount of powder, but it’s extra strong you’re heading for an overdose.”

He noted during the Chicago epidemic, many emergency rooms ran out of naloxone, the agent used to counter the effects of opiate overdose. A typical overdose case, Kendall said, requires 0.4 milligrams of naloxone, whereas a fentanyl-related overdose may need six or seven milligrams.

The health ministry warns that people handling illicit drugs should use extreme caution, as fentanyl can be absorbed through mucous membranes and can cause severe adverse reactions and even death.

The Vancouver Police department is so worried about the danger of handling the drug that it issued a warning to its own officers to be extremely careful, said Const. Brian Montague.

The department recently made two seizures of what it initially thought was cocaine and oxycodone, but tests revealed it was fentanyl.

“We’ve told our officers to be extremely careful as this can be hazardous to someone handling it,” Montague said. “We have been finding fentanyl is being manufactured in backroom labs. If someone takes it thinking they are taking heroin, they can very easily overdose.”

Prince George RCMP earlier this month also warned of the dangers of fentanyl after seizing a quantity of homemade products following two overdose deaths.

The B.C. Coroners Service recently conducted a review of overdose deaths between 2005 and 2010. It showed that 61 per cent were accidental and related to the use of prescription drugs.

It identified as the leading cause of drug-related deaths the following: codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine and oxycodone.

The study found that during the same period, 34 per cent of deaths associated with prescription drugs were classified as suicides.

The review found that 58 per cent of those who died from prescription drugs were between the ages of 40 and 59.

It also found the mortality rate from such overdoses was almost twice as high in the Interior as in other parts of the province, with a death rate of 2.8 per 100,000 compared to 1.3 per 100,000 in Metro Vancouver.

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